RULES AND REGULATIONS FOR SCHOOL HEALTH PROGRAMS

RULES AND REGULATIONS FOR

SCHOOL HEALTH PROGRAMS

[R16-21-SCHO]

STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS

DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION DEPARTMENT OF HEALTH

January 1964

As Amended:

March 1979 December 1980 May 1989 December 1989 March 1993

January 2007 (re-filing

in accordance with the provisions of section 42-35-4.1 of the Rhode Island General Laws, as amended)

January 1996

January 2007

December 1998

January 2009

December 1999

December 2000

January 2002 (re-filing

in accordance with the provisions of section 42-35-4.1 of the Rhode Island General Laws, as amended)

January 2012 (re-filing

in accordance with the provisions of section 42-35-4.1 of the Rhode Island General Laws, as amended)

July 2014

October 2003 June 2005

INTRODUCTION These amended Rules and Regulations for School Health Programs [(R16-21-SCHO] are promulgated pursuant to the authority conferred under RIGL Chapters 16-21, 35-4 and 23-1-18(4), and are established for the purpose of adopting prevailing standards pertaining to school health programs. Pursuant to the provisions of ?42-35-3(a)(3) and ? 42-35.1-4 of the General Laws of Rhode Island, as amended, the following were given consideration in arriving at these amended regulations: (1) alternative approaches to the regulations; (2) overlap or duplication with other state regulations; and (3) significant economic impact on small business. Based on the available information, no known alternative approach, overlap or duplication was identified. Professional staff at the Departments of Health and Education shall be available to provide guidance on the implementation of these Regulations, as needed. Upon promulgation of these amendments, these amended Regulations shall supersede all previous Rules and Regulations for School Health Programs [R16-21-SCHO] promulgated by the Departments of Education and Health and filed with the Secretary of State.

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TABLE OF CONTENTS

Page

PART I DEFINITIONS & GENERAL REQUIREMENTS

1

1.0 Definitions

1

2.0 General Requirements

7

2.8 Child Abuse/Neglect Reporting Requirements

8

2.10 Health and Wellness Subcommittee

9

PART II HEALTH EDUCATION AND PHYSICAL EDUCATION

10

3.0 Administration of the Health Education Program

10

4.0 Health Education Curriculum

11

5.0 Mandated Health Instructional Outcomes: Required Content Areas

12

6.0 Physical Education Curriculum

14

PART III HEALTH SERVICES

15

7.0 Responsibility for Services

15

8.0 School Personnel

16

9.0 Health Examinations

19

10.0 Vision Screening

20

11.0 Hearing Screening

23

12.0 Speech/Language Screening

25

13.0 Scoliosis Screening

26

14.0 Dental Health Screening

27

15.0 Health Records

28

16.0 Notification of Parents

30

17.0 School Reporting Requirements

30

18.0 First Aid and Emergencies

31

18.18 Concussions and Head Injuries in Recreational and/or Athletic Competition

36

19.0 Diabetes Care Management

36

20.0 Medication Administration

38

21.0 Immunization and Testing for Communicable Diseases

40

PART IV

HEALTHFUL SCHOOL ENVIRONMENT

42

22.0 Standards for School Buildings and Approval

42

23.0 New Construction (School Building)/General Requirements

42

24.0 Existing School Buildings/General Requirements

43

25.0 Pesticide Applications and Notifications of Pesticide Applications at School

44

26.0 Asbestos

46

27.0 Lead

47

28.0 Radon

47

29.0 Latex Gloves

48

30.0 Food Service

48

30.7 Healthier Beverages and Healthier Snacks

50

31.0 Health Room

50

32.0 Sanitation

51

33.0 Housekeeping

51

34.0 Swimming Pools

52

35.0 Water Supply

52

36.0 Tobacco

52

37.0 School Safety Plans / School Safety Teams / School Crisis Response Teams / School Safety Assessments /

Statewide Bullying Policy

53

37.7 Statewide Bullying Policy

57

38.0 Weapons and Firearms

59

39.0 Alcohol and Other Drugs

60

40.0 Recreational Facilities

60

41.0 Laboratories, Shops and Other Special Purpose Areas

60

41.2 Chemical Hygiene Plan

61

42.0 Vehicular and Pedestrian Traffic Safety

62

43.0 Asset Protection

62

PART V ENFORCEMENT & SEVERABILITY

63

44.0 Enforcement

63

45.0 Severability

63

REFERENCES

64

APPENDIX "A"

67

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PART I

DEFINITIONS AND GENERAL REQUIREMENTS

Section 1.0 Definitions Wherever used in these rules and regulations the terms listed below shall be construed as follows:

1.1 "Added sweetener" shall mean any additive, including natural or artificial additives that enhances the sweetness of the beverage, including, added sugar, but does not include, the naturally occurring sugar or sugars that are contained within milk or fruit juice.

1.2 "Anaphylaxis" refers to a potentially fatal, acute allergic reaction to a substance (such as stinging insects, foods and medications) that is induced by an exposure to the substance. Manifestations of anaphylaxis may be cutaneous (such as hives, itchiness, swelling), cardiorespiratory (swelling of tongue, throat, wheezing, difficulty breathing, low blood pressure), central nervous system (lethargy, coma) and others.

1.3 "At school", as used in ?37.0 and ?38.0 of these Regulations, means in a classroom, elsewhere on or immediately adjacent to school premises, on a school bus or other schoolrelated vehicle, at an official school bus stop, or at any school-sponsored activity or event whether or not it is held on school premises, or using property or equipment provided by the school that creates a material and substantial disruption of the education process or the orderly operation of the school.

1.4 "Audiologist" means an individual licensed in this state in accordance with the Rules and Regulations for Licensing Speech Pathologists and Audiologists (R5-48-SPA) [Reference 8] who specializes in preventing, identifying, and assessing hearing disorders, as well as providing audiologic treatment including hearing aids and other assistive listening devices.

1.5 "Audiometric aide" means an individual registered in this state in accordance with the Rules

and Regulations for Licensing Speech Pathologists and Audiologists (R5-48-SPA) [Reference 8].

1.6 "Bullying and Cyber-Bullying", as used in these Regulations, are defined by RIGL ?16-2133 and ?37.7(a) of these Regulations.

1.7 "Certified health educator" means an individual who holds the appropriate certification as a health educator in accordance with the requirements of the Rhode Island Department of Elementary and Secondary Education.

1.8 "Certified school nurse-teacher" means an individual who is licensed as a professional (registered) nurse in this state pursuant to RIGL Chapter 5-34 and is certified by the Rhode Island Department of Elementary and Secondary Education as a Certified School NurseTeacher.

1.9 "Community" means any city, town or regional school district established pursuant to state law and/or the Department for Children, Youth, and Families and any school operated by the state Department of Elementary and Secondary Education; provided, however, that the Department for Children, Youth and Families shall not have those administrative responsibilities and obligations as set forth in RIGL Chapter 16-2 ("Education"); provided, however, the member towns of the Chariho Regional High School District, created by RIGL

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Chapter 55 shall constitute separate and individual communities for the purpose of determining and distributing said Foundation Level School support including state aid for non-capital excess expenses for the special education of handicapped children provided for in RIGL Chapter 16-24-6 for all grades financed in whole or in part by said towns irrespective of any regionalization pursuant to RIGL Chapter 16-7 entitled, "Foundation Level School Support."

1.10 "Confidential health care information" means all information relating to a patient's health care history, diagnosis, condition, treatment or evaluation obtained from a health care provider who has treated the patient.

1.11 "Controlled substance" means a drug, substance, or immediate precursor in schedules I--V of RIGL Chapter 21-28-1.02.

1.12 "Dating partner" means any person involved in an intimate association with another, primarily characterized by the expectation of affectionate involvement, whether casual, serious, or long-term.

1.13 "Dating violence" means a pattern of behavior wherein a person uses threats of, or actually uses, physical, sexual, verbal or emotional abuse to control his or her dating partner.

1.14 "Dental hygienist", as used in these Regulations, means an individual licensed to practice dental hygiene in the United States.

1.15 "Dentist", as used in these Regulations, means an individual licensed in the United States to practice dentistry.

1.16 "Education record" means those records that are:

(1) Directly related to a student; and

(2) Maintained by an educational agency or institution or by a party acting for the agency or institution.

1.17 "Emergency" means a medical or psychological condition where the absence of immediate intervention could reasonably be expected to result in placing the student's health (or another student's health) in serious jeopardy; serious impairment to bodily or psychological functions; or serious dysfunction of any bodily organ or part.

1.18 "Emergency care plan (ECP)" means a set of procedural guidelines that provides specific directions about what to do in a particular emergency situation. A student with special health care needs may have both an ECP and an individualized health care plan (IHCP). The ECP may be formulated as part of the IHCP. As used in these Regulations, "emergency care plan (ECP)" shall have the same meaning as "emergency health care plan (EHCP)."

1.19 "Epinephrine auto-injectors" refers to any device that is used for the automatic injection of epinephrine into the human body to prevent or treat anaphylaxis.

1.20 "Eye care provider", as used in these Regulations, means an individual licensed in the United States to practice optometry or medicine (i.e., ophthalmology).

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1.21 "Follow up" means the contact with a student, parent as defined in these Regulations, and/or service provider to verify receipt of services, provide clarification and determine the need for additional assistance.

1.22 The "governing body" means the body or board or committee or individual, or the designated agent(s) or designee(s) of the aforementioned, responsible for, or who has control over, the administration of any elementary or secondary school, public or non-public, in the state of Rhode Island.

1.23 "Hazardous chemical" means a chemical for which there is statistically significant evidence based on at least one study conducted in accordance with established scientific principles that acute or chronic health effects may occur in exposed employees. The term "health hazard" includes chemicals that are carcinogens, toxic or highly toxic agents, reproductive toxins, irritants, corrosives, sensitizers, hepatotoxins, nephrotoxins, neurotoxins, agents that act on the hematopoietic systems, and agents that damage the lungs, skin, eyes, or mucous membranes.

1.24 "Health" is the quality of a person's physical, psychological, and sociological functioning that enables him or her to deal effectively with self and others in a variety of situations.

1.25 "Health care provider/agency" means any person/agency licensed by this state to provide or otherwise lawfully able to provide health care services, including, but not limited to, a physician, chiropractor, hospital, intermediate care facility or other health care facility, dentist, dental hygienist, nurse, physician assistant, nurse practitioner, optometrist, podiatrist, pharmacist, physical therapist, psychiatric/clinical social worker, mental health counselor, or psychologist and any officer, employee or agent of that provider acting in the course and scope of his/her employment or agency related to or supportive of health services.

1.26 "Health education" means comprehensive sequential K through 12 instruction that builds a foundation of health knowledge, develops the motivation and skills required of students to cope with challenges to health and provides learning opportunities designed to favorably influence health attitudes, practices and behavior that will impact lifestyles, educational performance and achievements and long range health outcomes and is in accordance with the requirements of ?3.4 of these Regulations.

1.27 "Healthier beverages" shall be defined as:

1.27.1 Water, including carbonated water, flavored or sweetened with one hundred percent (100%) fruit juice and containing no added sweetener.

1.27.2 Two percent (2%) fat milk, one percent (1%) fat milk, nonfat milk, and dairy alternatives, such as fortified soy beverages; plain or flavored, with a sugar content of not more than four (4) grams per ounce.

1.27.3 One hundred percent (100%) fruit juice or fruit based drinks that are composed of no less than fifty percent (50%) fruit juice and have no added sweetener.

1.27.4 Vegetable-based drinks that are composed of no less than fifty percent (50%) vegetable juice and have no added sweetener.

1.28 "Healthier snacks" shall be defined as:

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1.28.1 Individually sold portions of nuts, nut butters, seeds, eggs, and cheese packaged for individual sale, fruit, vegetables that have not been deep fried, and legumes.

1.28.2 Individually sold portions of low fat yogurt with not more than four (4) grams of total carbohydrates (including both naturally occurring and added sugars) per ounce and reduced fat or low fat cheese packaged for individual sale.

1.28.3 Individually sold enriched or fortified grain or grain product; or whole grain food items that meet all of the following standards based on manufacturers' nutritional data or nutrient facts labels:

(i) Not more than thirty percent (30%) of its total calories shall be from fat.

(ii) Not more than ten percent (10%) of its total calories shall be from saturated fat.

(iii) Not more than seven (7) grams of total sugar (includes both naturally occurring and added sugars) per ounce.

1.29 "Hearing impairment" means an impairment in hearing, whether permanent or fluctuating, that affects a student's educational performance.

1.30 "Individualized health care plan (IHCP)" means a comprehensive plan for care of children with special health care needs developed by the certified school nurse teacher in collaboration with the student, parents/guardians, school staff, community, and health care provider(s), as appropriate.

1.31 "Individualized health services" means services provided to individual students who attend school within the community which are specific to the health needs of the individual student, such as medication administration, and are not included in the health examination/ screenings, record keeping and reporting requirements described in ?7.1.1 of these Regulations.

1.32 "Laboratory" means a facility where the laboratory use of hazardous chemicals occurs. It is a place where relatively small quantities of hazardous chemicals are used on a nonproduction basis.

1.33 "Local education agency" means an educational agency at the local level that exists primarily to operate schools or to contract for educational services for elementary and secondary public and non-profit private schools. For non-profit private schools, this includes the building owner.

1.34 "Mandated instructional outcomes" are statements which indicate what health knowledge and skills students should have at the completion of a specific health unit.

1.35 "Medically accurate" means verified or supported by research conducted in compliance with accepted scientific methods and published in peer-reviewed journals, where appropriate, and recognized as accurate and objective by professional organizations and agencies with expertise in the relevant field, such as the federal Centers for Disease Control and Prevention.

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1.36 "Medication" means any FDA-approved substance regarded as effective for the use for which it is designed in bringing about the recovery, maintenance or restoration of health, or the normal functioning of the body.

1.37 "Parent" means a natural parent, a legal guardian or an individual acting as a parent in the absence of a parent or a legal guardian.

1.38 "Physician", as used in these Regulations, means an individual licensed in the United States to practice allopathic or osteopathic medicine. Chiropractic physicians licensed under the provisions of RIGL Chapter 5-30 shall be entitled to the same services of the laboratories of the Department of Health and other institutions, and shall be subject to the same duties and liabilities, and shall be entitled to the same rights and privileges in their professional calling pertaining to public health which may be imposed or given by law or regulations upon or to physicians qualified to practice medicine by RIGL ?5-37-2; provided, however, that chiropractic physicians shall not write prescriptions for drugs for internal medication nor practice major surgery.

1.39 "Population-based health services" means services provided to all students attending school within the community which are not focused on the individual health needs of the particular student but are provided to all students as part of the health examination/screenings, record keeping and reporting requirements described in ?7.1.1 of these Regulations.

1.40 "Prescription" means an order for medication signed by a licensed practitioner with prescriptive authority or transmitted by the practitioner to a pharmacist by telephone, facsimile, or other means of communication and recorded in writing by the pharmacist.

1.41 "Record" means any information recorded in any way, including, but not limited to, handwriting, print, tape, electronic storage, computer diskette, film, microfilm, and microfiche.

1.42 "RIGL" means Rhode Island General Laws, as amended.

1.43 "School" means all public or privately supported schools for students in grades Kindergarten (K) through 12 in Rhode Island. In addition, a preschool program operated by or within an approved school (per the requirements of ?2.1 of these Regulations) shall be considered a "school" for the purposes of these Regulations.

1.44 "School personnel" means all persons employed directly by the school or under contract to the school.

1.45 "Scoliosis screening" means screening for detection of an abnormal curvature of the spine, as defined by current American Academy of Orthopaedic Surgeons and Scoliosis Research Society standards.

1.46 "Self-administration" of medication means that the student uses the medication with parental authorization in the manner directed by the health care provider, and by following the age appropriate instructions on the OTC medication label, without additional assistance or direction.

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